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Lessons learned analyzing complications after laparoscopic total gastrectomy for gastric cancer / Lições aprendidas analisando complicações da gastrectomia total laparoscópica para câncer gástrico
Braghetto, Italo; Lanzarini, Enrique; Musleh, Maher; Gutiérrez, Luis; Molina, Juan Carlos; Korn, Owen; Figueroa, Manuel; Lasnibat, Juan Pablo; Orellana, Omar.
  • Braghetto, Italo; University of Chile. Faculty of Medicine. Hospital José J Aguirre. Santiago. CL
  • Lanzarini, Enrique; University of Chile. Faculty of Medicine. Hospital José J. Aguirre. Santiago. CL
  • Musleh, Maher; University of Chile. Faculty of Medicine. Hospital José J. Aguirre. Santiago. CL
  • Gutiérrez, Luis; University of Chile. Faculty of Medicine. Hospital José J. Aguirre. Santiago. CL
  • Molina, Juan Carlos; University of Chile. Faculty of Medicine. Hospital José J. Aguirre. Santiago. CL
  • Korn, Owen; University of Chile. Faculty of Medicine. Hospital José J. Aguirre. Santiago. CL
  • Figueroa, Manuel; University of Chile. Faculty of Medicine. Hospital José J. Aguirre. Santiago. CL
  • Lasnibat, Juan Pablo; University of Chile. Faculty of Medicine. Hospital José J. Aguirre. Santiago. CL
  • Orellana, Omar; University of Chile. Faculty of Medicine. Hospital José J. Aguirre. Santiago. CL
ABCD (São Paulo, Impr.) ; 33(3): e1539, 2020. tab, graf
Article in English | LILACS | ID: biblio-1141904
ABSTRACT
ABSTRACT

Background:

Laparoscopic surgery has been gradually accepted as an option for the surgical treatment ofgastric cancer. There are still points that are controversial or situations that are eventually associated with intra-operative difficulties or postoperative complications.

Aim:

To establish the relationship between the difficulties during the execution of total gastrectomy and the occurrence of eventual postoperative complications.

Method:

The operative protocols and postoperative evolution of 74 patients operated for gastriccancer, who were subjected to laparoscopic total gastrectomy (inclusion criteria) were reviewed. The intraoperative difficulties recorded in the operative protocol and postoperative complications of a surgical nature wereanalyzed (inclusion criteria). Postoperative medical complications were excluded (exclusion criteria). For the discussion, an extensive bibliographical review was carried out.

Results:

Intra-operative difficulties or complications reported correspond to 33/74 and of these; 18 events (54.5%) were related to postoperative complications and six were absolutely unexpected. The more frequent were leaks of the anastomosis and leaks of the duodenal stump; however, other rare complications were observed. Seven were managed with conservative measures and 17 (22.9%) required surgical re-exploration, with a postoperative mortality of two patients (2.7%).

Conclusion:

We have learned that there are infrequent and unexpected complications; the treating team must be mindful of and, in front of suspicion of complications, anappropriate decision must be done which includes early re-exploration. Finally, after the experience reported, some complications should be avoided.
RESUMO
RESUMO Racional A cirurgia laparoscópica tem sido gradualmente aceita como opção para o tratamento cirúrgico do câncer gástrico. Ainda existem pontos controversos ou situações eventualmente associadas a dificuldades intra-operatórias ou complicações pós-operatórias.

Objetivo:

Estabelecer a relação entre as dificuldades durante a execução da gastrectomia total e a ocorrência de eventuais complicações pós-operatórias.

Método:

Foram revisados ​​os protocolos operatórios e a evolução pós-operatória de 74 pacientes operados por câncer gástrico, submetidos à gastrectomia total laparoscópica (critérios de inclusão). Foram analisadas as dificuldades intraoperatórias registradas no protocolo operatório e as complicações pós-operatórias de natureza cirúrgica (critérios de inclusão). As complicações médicas pós-operatórias foram excluídas (critérios de exclusão). Para a discussão, foi realizada extensa revisão bibliográfica.

Resultados:

Dificuldades ou complicações intraoperatórias relatadas corresponderam a 33/74 e destas 18 (54,5%) foram relacionadas com complicações pós-operatórias e seis absolutamente inesperadas. As mais frequentes foram vazamentos da anastomose e do coto duodenal; no entretanto, outras complicações raras foram observadas. Sete foram tratados com medidas conservadoras e 17 (22,9%) necessitaram de re-exploração cirúrgica, com mortalidade pós-operatória de dois pacientes (2,7%).

Conclusão:

Aprendemos que existem complicações infrequentes e inesperadas; a equipe de tratamento deve estar atenta e diante da suspeita de complicação, decisão apropriada pode incluir uma nova exploração precoce. Finalmente, após a experiência relatada, algumas complicações devem ser evitadas.
Subject(s)


Full text: Available Index: LILACS (Americas) Main subject: Postoperative Complications / Stomach Neoplasms / Laparoscopy / Gastrectomy Type of study: Practice guideline / Observational study / Prognostic study / Risk factors Limits: Humans Language: English Journal: ABCD (São Paulo, Impr.) Year: 2020 Type: Article Affiliation country: Chile Institution/Affiliation country: University of Chile/CL

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Full text: Available Index: LILACS (Americas) Main subject: Postoperative Complications / Stomach Neoplasms / Laparoscopy / Gastrectomy Type of study: Practice guideline / Observational study / Prognostic study / Risk factors Limits: Humans Language: English Journal: ABCD (São Paulo, Impr.) Year: 2020 Type: Article Affiliation country: Chile Institution/Affiliation country: University of Chile/CL